Neuropathic pain: Chronic condition of the nervous system
Introduction
Neuropathic pain is defined as the one caused by an injury or dysfunction of the nervous system. It is a neurological condition that appears as a result of alterations of the nervous system, both peripheral peripheral neuropathic pain and central central neuropathic pain. It is characterized by the presence of paradoxical sensations with pain as a dominant positive symptom, combined with decreased sensitivity, secondary to nerve injury, simultaneous presence of hypersensitivity and hypo sensitivity.
Developing.
The sensitive alterations characteristics in this type of pain are crucial findings in the diagnosis that differentiate it from other types of pain. Pain is an alarm system that warns that there is current or potential damage and allows us to protect us from that damage, constituting a defense mechanism. When the pain extends for more than three months, it is called chronic pain, transforming into a pathological entity itself, this chronic pain syndrome has its origin in a structural damage of the nociceptive pathways, which can involve the peripheral receptor, thedriving and / or brain routes.
These changes condition one of their main characteristics: they do not require a stimulus of the nociceptors so that the pain manifests, implies that there is no transduction or conversion of a nociceptive stimulus, whatever it is, in an electrical impulse. Such fact is what allows neuropathic pain to be considered a neurological disease. The nociceptive pain on the contrary is shown by physiological stimuli, such as inflammation, heat or pressure in the corresponding nociceptors, generating an response that is usually of limited duration and that is not normally associated with a nervous system injury.
It constitutes an important alarm and defense system, since it allows to detect the presence of current or potential organic damage. A structural lesion of a nerve derives to chronic pain with greater probability than the pain caused by damage damage, it is characterized by a bad response to conventional analgesics and is usually more refractory in handling. The symptoms dependent on the pathophysiological phenomena associated with personal and environmental factors, which to the pain phenotype. They are presented as both negative and positive symptoms.
Negative symptoms indicate sensory deficit and positive. The multidimensional nature of pain also makes it accompanied with symptoms such as depression, somatization or insomnia, it is therefore frequent, which is accompanied by sleep disorders and psychological alterations, which can derive in depressive and anxious, potentially severe paintings.
Conclusions.
Neuropathic pain is present in 20% of chronic pain consultation. It is more difficult to treat than the nociceptive pain. It has special characteristics of recognition and treatment. Many times it is subsidized and sub -treated. The tricyclic, dual antidepressants, gabapentinoids and local anesthetics, have demonstrated efficacy in neuropathic pain and are recommended as the first line of use. Opioids can be used associated in case of intense pain. Despite the large number of clinical trials in recent years, based on pain production mechanisms, it is still necessary, consensus and management guides, since it remains a difficult pain to treat
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